Guest Julian F, Fuller Graham W, Vowden Peter, Vowden Kathryn Ruth
Catalyst Health Economics Consultants, Rickmansworth, UK.
Faculty of Life Sciences and Medicine, King's College, London, UK.
BMJ Open. 2018 Jul 25;8(7):e021769. doi: 10.1136/bmjopen-2018-021769.
The aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK's National Health Service (NHS), and the associated costs of patient management.
This was a retrospective cohort analysis of the records of 209 patients identified within a randomly selected population of 6000 patients with any type of wound obtained from The Health Improvement Network (THIN) Database, who developed a PU in the community and excluded hospital-acquired PUs. Patients' characteristics, wound-related health outcomes and healthcare resource use were quantified over 12 months from initial presentation, and the corresponding total NHS cost of patient management was estimated at 2015/2016 prices.
50% of all the PUs healed within 12 months from initial presentation, but this varied between 100% for category 1 ulcers and 21% for category 4 ulcers. The mean time to healing ranged from 1.0 month for a category 1 ulcer to 8 months for a category 3/4 ulcer and 10 months for an unstageable ulcer. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 53% of all the ulcers may have been clinically infected at the time of presentation, and 35% of patients subsequently developed a putative wound infection a mean 4.7 months after initial presentation. The mean NHS cost of wound care over 12 months ranged from £1400 for a category 1 ulcer to >£8500 for the other categories of ulcer. Additionally, the cost of managing an unhealed ulcer was 2.4 times more than that of managing a healed ulcer (mean of £5140 vs £12 300 per ulcer).
This study provides important insights into a number of aspects of PU management in clinical practice in the community that have been difficult to ascertain from other studies, and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.
本研究旨在评估英国国家医疗服务体系（NHS）在社区临床实践中管理压疮（PU）的护理模式、年度医疗资源使用水平以及患者管理的相关成本。
这是一项回顾性队列分析，从健康改善网络（THIN）数据库中随机选取的6000例患有任何类型伤口的患者群体中确定了209例患者的记录，这些患者在社区中发生了压疮，排除医院获得性压疮。从初次就诊开始的12个月内对患者的特征、伤口相关健康结局和医疗资源使用进行量化，并按照2015/2016年价格估算患者管理的相应NHS总成本。
所有压疮中有50%在初次就诊后的12个月内愈合，但不同类型的愈合情况有所不同，1类溃疡的愈合率为100%，4类溃疡为21%。愈合的平均时间从1类溃疡的1.0个月到3/4类溃疡的8个月以及不可分期溃疡的10个月不等。患者主要由社区护士管理，专科临床医生的临床参与极少。所有溃疡中高达%在就诊时可能已发生临床感染，35%的患者随后在初次就诊后平均4.7个月发生疑似伤口感染。12个月内伤口护理的平均NHS成本从1类溃疡的1400英镑到其他类型溃疡的超过8500英镑不等。此外，管理未愈合溃疡的成本是管理已愈合溃疡成本的2.4倍（每例溃疡平均分别为5140英镑和12300英镑）。
本研究为社区临床实践中压疮管理的多个方面提供了重要见解，这些方面难以从其他研究中确定，并提供了NHS资源使用和成本的最佳可用估计，可为政策和预算决策提供参考。
